Understanding Home Health Care
If your patient is going home and not in to extended care, she may benefit from home health care. The discharge planner will have explored this option with her and her family. Sometimes patients refuse home health care, often because they don't understand its purpose or role in their recovery.What Home Health Care Is
Home health care provides a continuum of care from the acute hospitalization to help the patient adjust at home. Patient teaching is a primary function in the home. It is provided on an intermittent basis, meaning the nurse or therapist makes a visit to perform the care. This is not the same as private duty home care where a nurse or other caregiver is hired for shift work. A nurse may also be required to make a few follow up visits for such things as assessment and teaching for post-op care or for assessing respiratory status after a bout of pneumonia.
Physical, occupational, and speech therapy can be provided in the home. Nursing tasks can include such things as IVs, tube feedings, wound and ostomy care, diabetic instruction, and general assessment of systems until symptoms such as hypertension or congestive heart failure (CHF) are stabilized. Home health aide (HHA) visits may also be included, as indicated, for personal care as long as there is a skilled need as well. A medical social worker (MSW) could also be indicated to assist with short- and long-term planning arrangements and referrals to community resources.What Home Health Care Is Not
Home health visits are intermittent and not intended to be long term. The patient and perhaps a caregiver will be instructed in the care needed and then the visits are tapered off or ended. The expectation is that the patient and family will assume responsibility for care. This includes learning such things as injections, wound and ostomy care, and tube feedings.
Patients often go home expecting that a nurse will be coming to stay with them for an extended period of time, but this is not the case. Typically, the nurse or therapist won't visit until the next day after discharge unless there are specific procedures such as IVs, tube feedings, or frequent dressing changes that require a same day visit. Patients also participate in IV care, and the nurse is then available for site changes and problem solving. The nurse might visit monthly to change a Foley catheter or G-tube, but the family handles the everyday care or feedings.Paying for Home Health Care
The Home Health Agency will notify the patient when reimbursement will end, and the patient or caregivers may opt to pay privately to continue care. In most cases, the care is not needed, and the patient and family are prepared to continue on their own. If the patient's needs change, home health care could be utilized again if all criteria are met.
Some private duty nursing care can be reimbursed by Medicaid and private insurance. This type of care might include such things as ventilator care or other complex skilled care. Custodial care is not reimbursed by Medicare or Medicaid and only rarely covered under private insurance. This is an out-of-pocket expense. This level of care is available from private duty agencies (which might be part of the home health agency or a sister company) or by hiring individuals privately.
An M.D. must order all the care and be willing to oversee and provide continuing orders. In most cases (Medicare especially), the patient must be homebound for the duration of the home care, and there must be a skilled need for nursing or therapy. If all these criteria are met, the care is usually covered by third party payers (insurance, Medicare, or Medicaid).
Two of the most common inquiries to home health agencies are how to get custodial care and why isn't it covered by Medicare or insurance. Most patients can benefit from a home health referral if for no other reason than for a physical therapist (PT) for a home safety evaluation and a couple of visits from a nurse for follow-up teaching about medications and assessment of the underlying event or illness that caused the hospitalization. Then they can also refer to the MSW for a visit to explore resources and to set in motion short- and long-term plans for assistance and care.